Hepatocellular Adenoma Clinical Presentation

Updated: Feb 21, 2018
  • Author: Bradford A Whitmer, DO; Chief Editor: BS Anand, MD  more...
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The clinical presentation varies widely. Salient features of the history and physical examination may include the following:

  • Pain in the right upper quadrant or epigastric region is common, occurring in 25-50% of patients with hepatocellular adenomas.

  • Lesions may be noticed by patients as a palpable mass. Lesions may also be discovered incidentally during an abdominal imaging study for an unrelated reason.

  • History of birth control or anabolic steroid use should be elicited in patients with suspected hepatocellular adenomas.

  • Patients may also present with severe, acute abdominal pain with bleeding into the abdomen, which results in signs of shock (eg, hypotension, tachycardia, diaphoresis).

  • Hemoperitoneum occurs more frequently if the patient is taking a high-dose OCP, is actively menstruating or pregnant, or is within 6 weeks postpartum. Location of the lesion also is important, with those near the surface of the liver more prone to causing hemoperitoneum.


Physical Examination

The physical examination findings are often nonspecific. Patients may be asymptomatic, or they may appear ill, with pallor and abdominal distress. Note the following:

  • Palpable tender or nontender mass in the right hypochondrium

  • Findings consistent with hemorrhage

  • Vital signs

  • Tachycardia

  • Hypotension

  • Orthostasis

  • Head, ears, eyes, nose, and throat (HEENT) examination

  • Anicteric sclera (Jaundice has been reported due to compression of the biliary tree by the tumor.)

  • Possible pale conjunctiva, if hemorrhage has occurred

  • Cardiovascular findings - Tachycardia if actively bleeding

  • Abdominal findings

  • Possible right hypochondrial mass with or without tenderness

  • Possible hepatomegaly

  • Possible fluid wave in cases of hemoperitoneum

  • Possible peritoneal signs, including guarding or rebound in cases of tumor rupture

  • Skin findings - Possible Grey-Turner sign or Cullen sign in cases of hemoperitoneum

  • Examination findings of the neck, chest, and extremities - Unremarkable

  • Neurologic examination findings - Unremarkable